Ukraine Injects Addicts With Hope

VILNIUS, Lithuania, Jun 11 2013 (IPS) - As former presidents, senior diplomats and experts meet in the Lithuanian capital to discuss a litany of rights abuses, lethal epidemics and social destruction caused by repressive drug policies in Eastern Europe and Central Asia, pockets of hope for drug reform are emerging across the region.

Eastern Europe and Central Asia (EECA) is home to over 3.7 million people who inject drugs – almost a quarter of people who inject worldwide. Injecting drug use is fuelling HIV and hepatitis C epidemics in most EECA countries – almost a third of injecting drug users in the region are thought to be living with HIV while even more are infected with hepatitis C.

Many EECA countries also have some of the world’s strictest legislation on drugs. Lengthy jail sentences are routinely imposed for even the most minor drugs offences, and government approaches to harm reduction – including needle exchanges, opioid substitution treatment and social support systems – range from apathetic to actively obstructive.

However, as the enormous scale of the HIV/AIDS and hepatitis C epidemics has emerged and authorities have begun to realise the massive public health implications of drug use, some governments are softening their drugs policies, albeit mildly.

Michel Kazatchine, the UN Secretary General’s special envoy on HIV/AIDS for East Europe and Central Asia, told IPS: “Countries across the Eurasian region, from the Ukraine to Belarus and all the way to Central Asia are showing signs of moving in a more positive direction on harm reduction.”

Delegates at the International Harm Reduction Conference in Vilnius Jun. 9-12 – which brought together more than 800 scientists, politicians, researchers, health workers, doctors and drug user activists from across the world – repeatedly heard how state drug policy across the region remains widely rooted in repression and criminalisation, compounding public health problems and having no effect on reducing drug use.

Drug addicts who spoke to IPS at the conference told stories of police waiting outside harm reduction service centres to arrest addicts for having dirty needles on them, and using the residue in their needles as proof of possession.

But what also emerged from the conference was the success of harm reduction efforts in some countries and surprising reform plans in others.

Georgia’s justice minister, Tea Tsulukiani, outlined plans for sweeping reforms of the former Soviet state’s drug policy. At present harm reduction services are not legalised, there is no treatment for drug users in prisons, and possession of even the smallest amounts of drugs can end in an 11-year jail sentence.

The ministry wants to decriminalise possession of small amounts of both soft and hard drugs, overhaul healthcare services for drug users, and legalise harm reduction.

Tsulukiani told IPS: “At the moment Georgia has a repressive machine to deal with drugs. This needs to be changed to a system that is fair and human.”

In Kazakhstan, meanwhile, the health ministry at the end of last year expanded opioid substitution therapy programmes, and there has been a significant upgrade of funding for harm reduction programmes. It has also introduced a large programme to tackle hepatitis C.

But arguably the greatest changes have been seen in Ukraine, which is already being hailed as a shining example for the rest of the region of how to implement harm reduction programmes and to successfully engage authorities on drug policy reforms.

Ukraine has struggled for the last decade with one of the fastest growing HIV/AIDS epidemics in the world, driven by injection drug use. There are an estimated 290,000 injecting drug users in Ukraine.

But last year, for the first time, the rate of new HIV infections in Ukraine dropped. This has been put down to the widespread implementation of harm reduction programmes.

The Ukrainian harm reduction group International HIV/AIDS Alliance Ukraine implements the largest HIV prevention programme in the EECA, supporting 170,000 drug users in more than 300 cities. The government also recently approved the country’s first hepatitis C programme to combat the epidemic in the country.

The programme was approved largely after sustained pressure from civil society groups who led dialogue with authorities, persuading them of the public health risk of the epidemic.

Andrij Klepikov, executive director of International HIV/AIDS Alliance Ukraine, said other countries in the region should try to follow their lead.

He told IPS: “We need to get the message out about our success. Our programmes have been a success and there is so much we can easily share with other countries in the region – there is no language barrier because Russian is widely spoken around the region and there are similar situations in many countries with regard to the drug problem and related health problems.

“Our experience could be really useful for them.”

Tsulukiani told IPS that Ukraine’s implementation of harm reduction services was one example which her ministry was looking at as it formulates a body of evidence to present to other ministries “to persuade them that by implementing reforms the situation with drug use will not get worse in Georgia.”

But as delegates at the conference heard, for all the progress in these countries, drug users continue to face human rights abuses, a chronic lack of access to harm reduction services and criminalisation which does nothing to combat addiction. Prisons remain flooded with illicit drugs and are breeding grounds for diseases such as HIV and hepatitis.

Tsulukiani told IPS that one of the “pillars” of the reforms she wants to push through in Georgia are changes in healthcare services for drug users and particularly for incarcerated drug users.

“Drug users are seen as criminals and put in prison. All they get there is detox, no treatment, and they come out psychologically destroyed,” she said.

However, some people are hopeful that the situation in the region can be changed for the better, as the example of Ukraine has shown.

Alexander Kwasniewksi, former president of Poland and member of the Global Commission on Drug Policy, told IPS: “It’s not all bad news in the EECA, there are positive things happening, such as law changes and the scaling-up of services in some countries.

“And while much, much more still needs to be done, we can look at the example of the Ukraine and see that with enough pressure and work from NGOs, change can definitely be effected.”